Dr Ravi C. Ratnavel DM (Oxon) FRCP (UK) TREATMENT OF SKIN CONDITIONS BY UVB PHOTHERAPY Ultraviolet radiation from artificial light sources (UV therapy) has been used by Dermatologists for almost 100 years and is a widely used and effective treatment in a number of skin disorders. These include psoriasis, eczema and acne. The choice of UVB over other forms of treatment depends on a wide range of factors including age, disease, skin type, previous therapy, and current medication. Dr Ratnavel s private patients are treated in the phototherapy units located within Buckinghamshire Hospitals Trust at Stoke Mandeville and Amersham hospitals. Most people are offered narrow-band UVB, which is the latest development in UV treatment of skin disorders. The state of art machines at these sites are regularly calibrated and maintained with safety of paramount importance. The dosage of radiation administered is carefully logged in computerised records by specialist state registered nurses. Following assessment at an initial consultation with Dr Ratnavel, a nurse will contact you to arrange 15-30 minute appointments (the number depends on skin disease). Patients should schedule a private appointment for review with Dr Ratnavel for 3-4 weeks after commencement of Opening Times Stoke Mandeville (Aylesbury): Treatment is given three times per week Monday, Wednesday and Friday 8.30 am 4.30 pm. The appointment time allocated to you will be the same at each visit. The Unit closed is closed on Public Holidays and weekends. In case of emergencies or if you need to cancel your appointment, please ring 01296 315756 or 01296 315551. Amersham (01494 734636 or 01494 734601): The Unit is open 1.30pm - 8.30pm Monday to Thursday and 7.30am - 3.00pm Saturdays (closed on Fridays, Sundays and Public Holidays). Treatment days are either Monday, Wednesday and Saturday or Monday, Thursday, Saturday. Procedure Your starting dose will be determined by how easily your skin burns or tans. At subsequent visits the dose increase will depend on skin type, disease and response (or lack of response) to the previous
Initially irradiation will take only a few minutes (or even seconds), gradually increasing to a maximum of 15 minutes. Usually you will develop mild redness with occasional minor discomfort after each You must inform the nurse when you feel the dose is exceeding your skin s tolerance so that we can reduce or stop further increments. You will know this is happening if you feel hot and uncomfortable and develop marked persisting skin redness a few hours after treatment (like mild sunburn). All treatments are nurse supervised and given in stand-up cabinets surrounded by fluorescent lamps. Usually eyes are shielded: If the eyelids are also affected patients may stand without goggles but with their eyes closed from the start of Gentleman will be asked to protect their genitalia. UVB is safe to use in pregnancy. Provided the eyes are properly shielded during treatment, there is no danger to those with cataracts, lens implants or other eye disorders. There is no need to protect your eyes after Adverse Effects: Side effects are common, usually mild and virtually never permanent. Most of them can be treated by creams or will spontaneously disappear a few days after stopping Erythema: We aim to produce a mild eczema (skin redness) after every treatment without associated discomfort. If the UV dose exceeds the skin s limit a more persistent uncomfortable erythema results ( a burn ). Occasionally, blisters develop. We may then suspend treatment and treat with a topical cream until symptoms have settled. Skin Dryness: There will be an increased tendency to dryness of the skin and this is one of the reasons we recommend the routine and increased use of moisturisers during therapy, minimum of twice daily for life. Folliculitis: Inflammation of hair follicles may occur. These do not cause discomfort and usually require no treatment or interruption of UV therapy. This may be prevented by applying your moisturiser in a downward motion only. Herpes Simplex: Those who have had cold sores previously may get a flare up and for this we recommend a sunscreen applications on the lips. Remember to ask the nurse for a lip sunscreen cream before every Photosensitivity: In those who have a co-existing photodermatosis i.e. a condition caused by UV light, a flare up may occur. Do s and Don ts:
Always remember to inform the Doctor or nurse if you are taking, or about to start any new medication for a non-dermatological condition while having UV therapy. Dry flaky skin will prevent UVB absorption and render the treatment ineffective. On UVB days, before treatment, use only Aqueous Cream, Diprobase Cream, Cetraben Cream, Doublebase or WSP 50/50 as a moisturiser. Avoid tar, steroid and vitamin preparations. After treatments and on non-treatment days the regular and liberal use of any moisturiser is recommended. Never use a sunbed or indulge in sunbathing during your course of Otherwise the cause and dose of redness or burning cannot be determined. On bright days cover all exposed areas from the light by wearing long sleeves, sun hats, sun block, gloves etc. Plants and weeds may have photosensitisers in them so avoid handling them on treatment days (e.g. cooking with celery, parsnips or figs). In order to maximise the benefits of UVB and so as not to inconvenience other patients, we insist on regular and punctual attendance. Treatment will be withdrawn if three or more appointments are missed without informing the nursing staff, or there are frequent cancellations or rescheduling. Jewellery e.g.rings, if worn at the start of treatment should then be worn at every treatment thereafter. These areas will burn if subsequently exposed. For the same reasons avoid radical hairstyle changes or cuts midway through Please do not bring children to the Department as nursing staff cannot be responsible for them whilst their parents/guardians are having
UVB PHOTOTHERAPY INITIATION FORM / Dr Ratnavel / Private Patient Name: Referred by: Dr Ratnavel (Private) DoB: Date: Address: Home Tel No: Work Tel No: Narrowband UVB therapy Initiation GP: Other contact: Dermatological diagnoses: Other medical/psychiatric disorders: Standard Regimen: Yes/No Skin Type: I/II/III/IV/V/VI Other comments: Allergies: If non standard regime define Photographs: Pre/Post Pedestal: In/Out Treat eyelids Yes/No Increments: % Every 1/2/3 visits Underwear: Yes/No Total no. of treatments: 20 24 /30 36 I have given the patient/guardian a UVB information sheet. A follow up appointment will be arranged by the Phototherapy staff/patient privately. Doctors signature:.. Date: Nurse at phototherapy suite to fill in this section: Current therapy (topical) Current therapy (systemic) Risk/Exclusion Factors Y N Risk/Exclusion Factors Y N Lupus Erytheamtosus H/o PUVA Renal/Liver Disease H/o UVB Previous radiotherapy Regular use of sun beds Arsenic therapy Lived > 1yr in sunny climes Immunosuppressant drugs Claustrophobia Cytoxic drugs Cold sores Personal h/o skin History of photosensitivity malignancy Psoralen allergy Photosensitising drugs Notify a Doctor if any italicised risk factors apply
Cumulative UVA dose J/cm 2 Cumulative no. of treatments Total broadband UVB mj/cm 2 Cumulative no. of treatments Total narrowband UVB mj/cm 2 Cumulative no. of treatments I have read and understood the information on UVB therapy and consent to me/my child having I am aware of the importance of regular and punctual attendance. Signature: Nurse/Witness: Date:... Name: Diagnosis:. Hospital No:. Date: Concurrent therapy: MED (UVB) mj/cm2. 70, 100, 140, 200, 280, 400, 560, 800 Start dose 105, 150, 210, 300, 420, 600, 840, 1200 Date: No: Dose mj/cm 2 Progress & Problems or other comments MED testing performed as per guidelines on GP start form completed Parking permit Previous notes requested Advised on moisturisers and topical applications: Any holidays planned in the next 2 months? Signature Nurse: Excellent/Good/Satisfactory/Poor Total No: of treatments: Cumulative: Patient evaluation: Excellent/Good/Satisfactory/Poor Total UVB dose mj/cm 2 Cumulative UVB dose mj/cm 2 *Remember to ask patients to schedule an appointment with Dr Ratnavel 3-4 weeks after starting treatment